Provider Demographics
NPI:1326002759
Name:HOLZIMMER, GERALD H (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:H
Last Name:HOLZIMMER
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11662 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-4588
Mailing Address - Country:US
Mailing Address - Phone:586-755-2650
Mailing Address - Fax:586-754-6407
Practice Address - Street 1:11662 MARTIN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4588
Practice Address - Country:US
Practice Address - Phone:586-755-2650
Practice Address - Fax:586-754-6407
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI080561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics